Summary
Independence Blue Cross reissued policy 08.02.04 on velmanase alfa-tycv (Lamzede) with no substantive changes to coverage criteria. The policy continues to cover this rare enzyme replacement therapy for non-CNS alpha-mannosidosis manifestations in patients age 3+ who meet specific diagnostic, baseline testing, and clinical criteria. Billing teams should verify no prior authorization workflow changes are needed and confirm continued eligibility requirements remain the same.
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What to do
Action · 8 steps
01No immediate action required.
02This is a reissue with no changes to the medical necessity criteria, dosing, frequency, or coverage requirements that were originally effective 03/11/2024.
03Billing team should.
04Confirm current billing workflows for HCPCS J0217 (velmanase alfa-tycv injection, 1 mg) remain unchanged.
05Verify that prior authorization processes, if in place, continue to include the documented baseline testing requirements (6-MWT, 3-MSCT, FVC, or BOT-2) and confirmation of diagnosis per policy.
06Retain the current policy reference (08.02.04, effective 03/11/2024) in billing system notes.
07Ensure claims continue to be processed with ICD-10 diagnosis code E77.1 (Defects in glycoprotein degradation) as applicable.
08No system changes or retraining are necessary due to this reissue.
Codes mentioned
J0217E77.1
Original notice
08.02.04, Velmanase alfa (Lamzede)
medpolicy.ibx.com · Always check the source before changing claims.